Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Groups
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name
*
Your answer
Are you interested in attending a group?
*
Yes
Maybe
What type of group(s) are you most interested in?
*
General support
Therapy group
Meal support
Combination
Other/Not sure
Required
Is cost a potential barrier?
Yes
No
Clear selection
What is the ideal time for you to meet?
Weekday mornings
Weekday afternoons
Weekday evenings
Weekends
No preference/Unsure
Clear selection
What is your preferred meeting location?
In-person (Carmel, IN location)
In-person (Indianapolis, IN location)
Virtual
No preference/Unsure
Clear selection
We are always open to exploring new groups based on needs and interests. Are there any topics that you think would be helpful or groups that you would be interested in attending? Please let us know your thoughts!
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Collaborative Counseling and Nutrition .
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report